Tue January 21, 2014

Diabetes, Cost Of Care Top Health Concerns For U.S. Latinos

A customer buys produce at the Euclid Market in the Boyle Heights neighborhood of East Los Angeles in December. The market was reopened in 2013 as part of a project to promote healthy eating among the city's Hispanic population.

Alex Ortega, a professor of public health at UCLA, looks over the produce at the market he and other community members helped reopen.

Courtesy of UCLA Fielding School of Public Health

Latino immigrants in the U.S. say the quality and affordability of health care is better in the U.S. than in the countries they came from, according to the latest survey by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. But many report having health care problems.

About a third of immigrant respondents (31 percent) said they'd had a serious problem with being able to pay for health insurance in the past 12 months. And more than 1 in 4 had a serious problem affording doctor and hospital bills and prescription medicines.

But the health issue that Latinos said is most concerning for them and their families — whether they were born in the U.S. or immigrated here — is diabetes. Last year, in another poll, Latinos said cancer was the biggest problem facing the country.

Hispanic populations have a high prevalence of Type 2 diabetes. About 10 percent of Latino adults have been diagnosed with it or have "prediabetes," a stage of the disease that often goes undetected.

One important factor: Latinos may be genetically predisposed to the disease — a risk that can be aggravated by environment and diet.

The Diabetes 'Plague'

Take the example of East Los Angeles, an area heavily populated by Mexican-Americans.

Like many of her friends and family members, Rebecca Martinez-Rocha says she struggles with her weight. At one point, she weighed more than 320 pounds.

"I don't think I realized it at the time, whether it was denial or I stopped getting on a scale," she says, "but I was morbidly obese."

And, as it turns out, Martinez-Rocha was prediabetic, a diagnosis she received at a local health clinic.

"I wasn't aware of the fact that I was ill; I figured that I was relatively young, in my 20s and early 30s," she says. "It was kind of one of those 'aha' moments in life, where you look at it and put it all together and you think, 'How did I get here?' "

Peters says Type 2 diabetes is the "plague" of the Latino community she treats: "Individuals here are getting diabetes at rates we've not seen before."

About 12 percent of the Latino population she sees has diabetes. Peters projects that number will climb to nearly 30 percent over the next few decades if nothing changes in the environment or diet of local residents.

Peters told Martinez-Rocha she was on her way to getting insulin-dependent Type 2 diabetes. Martinez-Rocha says she got very scared and made major changes. She lost 160 pounds.

But many patients don't do that, in large part because prediabetes is often "silent." Unless people go to a doctor and get their blood sugar measured, they'll never know they have it.

And that's a shame, Peters says, because prediabetes can be turned around. "If somebody has prediabetes, they need to lose weight — not a lot of weight, maybe only 10 to 15 pounds," she says.

They "don't have to become skinny" to benefit, she adds. Studies show that moderate weight loss can reduce diabetes risk by half.

Losing weight is hard for many people. But Martinez-Rocha says it's even harder when you live in a neighborhood that offers lots of high-fat, high-salt and high-sugar food.

Alex Ortega, a public health researcher and professor of public health at UCLA, calls neighborhoods like this, where healthy food is hard to come by, "food swamps."

Walk into the typical corner market, he says, and the first things you'll see are signs for liquor and lottery tickets, cigarettes, soda and chips. "They might sell some fruits and vegetables, but they're typically in the back of the store and in very poor quality," Ortega says.

Our survey found that Latino immigrants generally do not perceive their diets as less healthy in the U.S.: 38 percent see their diet as healthier in the United States, and about the same number (39 percent) say it's about as healthy. One in 5 (21 percent) see their diet as less healthy.

Previous studies have shown that obesity rates among immigrants increase as their duration of residence in the U.S. increases. They suggest this might be attributable in part to changes in lifestyle, including an unhealthy diet.

About a month ago, Ortega, along with community activists, local high school students and store owner Maria Avila, transformed the Euclid Market in the Boyle Heights section of East Los Angeles. They added windows and a new paint job, and rearranged and organized shelving. But most importantly, Ortega says, they added healthful foods.

The newly converted store opened to the public in December. Today, when you walk in the door, the first things you see aren't cigarettes and junk food — they're fresh fruits and vegetables.

This is the fourth corner store in the area to be converted. Ortega is still collecting data, but anecdotally, he says, store owners tell him they have more customers, they're selling more fruits and vegetables, and they're making more money.

But the big question is whether the availability of fresh fruits and vegetables will make a difference in the health of the neighborhood and the epidemic of diabetes.

Better Options, Better Diet

For college freshman DeeDee Barba, it has made a difference. She has taken part in the store conversion project for two years. Not only has she learned about marketing and sales, but she's also learned about nutrition. As a result, she says, her family now eats more healthfully. Part of that includes no dressing on salads.

"We now eat our salads with olive oil and lemon, and it's actually good," she says. "We eat a lot of fish and chicken; we rarely eat red meat. We eat rice, but we have whole-wheat rice. We don't drink soda anymore — we drink mostly water."

High school senior Steven Cardona, 17, has worked with the store conversion project for the past year. Learning about nutrition, he says, has changed his family's diet dramatically.

"Before, we would eat lots of fast food, but now we eat mostly steamed vegetables, rice, chicken and lean meats," he says. Family members have lost a lot of weight, and everybody reports feeling "better," he says.

Ortega says that's exactly what's hoped for: that the availability of healthy food in low-income neighborhoods like this will make a difference in what residents buy, cook and eat. And that it will mean changing diets and reducing the high rates of obesity and diabetes in the Latino community in East L.A.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

Now, along with those questions Gene mentioned, about finances and the American Dream, our joint poll on Latino Americans also asked about health. We're told that Latinos can be genetically predisposed to diabetes. Environment and diet can increase that risk. NPR's Patty Neighmond went to Boyle Heights in east Los Angeles, a neighborhood dominated by Mexican-Americans.

REBECCA MARTINEZ-ROCHA: I was born there, raised there, and still live there.

NEIGHMOND: And like many of her friends and family members, Martinez-Rocha struggles with her weight. At one point she was extremely obese.

MARTINEZ-ROCHA: I was well over 320 pounds. I don't think I realized it at the time, whether it was denial or I just stopped getting on the scale. I was morbidly obese.

NEIGHMOND: And, as it turns out, she was prediabetic, a diagnosis she received at the local health clinic.

MARTINEZ-ROCHA: I wasn't aware of the fact that I was ill. I figured since I was relatively young - I was in my late 20s, early 30s - and it was kind of one of those a-ha moments in life where you look at it and you put it all together and you think how did I get here?

NEIGHMOND: Her doctor, Anne Peters, is a diabetes specialist who also heads a diabetes research program at the University of Southern California.

DR. ANNE PETERS: Type two diabetes is the plague of this Latino community. Individuals here are getting diabetes at rates we've not seen before.

NEIGHMOND: Rates of about one in 10 people.

PETERS: I have seen more suffering from diabetes; from blindness, from kidney failure, from heart disease, from amputations. Untreated, diabetes is awful.

NEIGHMOND: Peters says if nothing changes, the rate of diabetes could rise over the coming decades to one-in-four. Peters told Martinez-Rocha she was on her way to becoming an insulin-dependent diabetic. Martinez-Rocha got really scared and made major changes. She lost 160 pounds. But many patients don't do that, in large part because pre-diabetes is silent. And if they don't go to a doctor and get their blood sugar measured they'll never know, which is a shame, says Peters, because pre-diabetes can be turned around.

PETERS: If somebody has pre-diabetes, they need to lose weight and they don't need to lose a lot of weight. It may only be 10 to 15, 20 pounds. It doesn't mean they have to become skinny.

NEIGHMOND: But weight is key, says Peters. Studies show that just moderate weight loss can reduce diabetes risk by half. Now, losing weight is hard for everyone. But Martinez-Rocha says it's even harder when you live in a neighborhood that offers lots of high-fat, high-sugar food.

MARTINEZ-ROCHA: Drive around my neighborhood, every corner you'll see a taco stand, a fast-food restaurant, a panaria(ph) which is, you know, sweet-bread store. You'll see a place that sells tamales. You'll see a place that sells some sort of other desert or fried food.

NEIGHMOND: In our poll with the Robert Wood Johnson Foundation and Harvard School of Public Health, we found that one-in-five Mexican-Americans say they have poor to fair access to fresh fruits and vegetables.

Alex Ortega is a professor of public health at UCLA. He calls neighborhoods like this food swaps, where corner markets typically don't offer healthy food.

ALEX ORTEGA: They'll sell lottery tickets, liquor, cigarettes. They might sell some fruits and vegetables, but they're typically in the back of the store and they tend to be of very poor quality.

(SOUNDBITE OF A CASH REGISTER)

UNIDENTIFIED WOMAN: (Spanish spoken)

NEIGHMOND: About a month ago at the Euclid Market in East L.A., storeowner Maria Avila worked with Ortega and local high school students to transform store. They added windows, a new paint job and, most importantly, healthy food. Now, when you walk in, the first things you see are fresh fruits and vegetables.

ORTEGA: Fresh tomatoes, you see some squash, you see avocados, you see apples, you know, a wide variety of fruits and vegetables that were not here couple of months ago.

NEIGHMOND: This is the fourth corner store in the area to be converted. It's part of a special project at UCLA. Ortega says storeowners tell him they have more customers. They're selling more fruits and vegetables and they're making more money - all around good news. But the big question, of course, is: Will it make a difference in the health of the neighborhood and the epidemic of diabetes.

Nineteen-year-old college freshman DeeDee Barba has been part of the store conversion project for two years. She's also learned about nutrition.

DEEDEE BARBA: We've always liked salads though. Like, that's actually been a big thing in our family - we do like salads a lot. But, you know, we would always eat them with dressing. And that's like, you know, when we started finding out, like, it's not so good with dressing and stuff. So we usually are salads with like, olive oil and lemon now. That's actually really good.

NEIGHMOND: For 17-year-old high school senior Steven Cardona, the family diet has changed dramatically.

STEVEN CARDONA: Before we would, you know, go to like Jack in the Box or something. You know, eats dinner with whatever. But the other day, we had some steamed vegetables, rice and a piece of chicken on the side. And, you know, little things like that, you know.

NEIGHMOND: Researcher Alex Ortega says the hope is the availability of healthy food in low-income neighborhoods like this will make a difference in rates of obesity and diabetes in the Latino community.